Pan Xiong-Fei, Griffiths Ulla K, Pennington Mark, Yu Hongjie, Jit Mark
Center for Clinical Epidemiology and Evidence-Based Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Renmin Nanlu 3-17, Chengdu 610041, China.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
Vaccine. 2015 Nov 17;33(46):6164-72. doi: 10.1016/j.vaccine.2015.09.081. Epub 2015 Oct 2.
The purpose of the study was to systematically review economic evaluations of vaccine programs conducted in mainland China. We searched for economic evaluations of vaccination in China published prior to August 3, 2015 in eight English-language and three Chinese-language databases. Each article was appraised against the 19-item Consensus on Health Economic Criteria list (CHEC-list). We found 23 papers evaluating vaccines against hepatitis B (8 articles), Streptococcus pneumoniae (5 articles), human papillomavirus (3 articles), Japanese encephalitis (2 articles), rotavirus (2 articles), hepatitis A (1 article), Enterovirus 71 (1 article) and influenza (1 article). Studies conformed to a mean of 12 (range: 6-18) items in the CHEC-list criteria. Five of six Chinese-language articles conformed to fewer than half of the 19 criteria items. The main criteria that studies failed to conform to included: inappropriate measurement (20 articles) and valuation (18 articles) of treatment and/or vaccination costs, no discussion about distributional implications (18 articles), missing major health outcomes (14 articles), no discussion about generalizability to other contexts (14 articles), and inadequate sensitivity analysis (13 articles). In addition, ten studies did not include major cost components of vaccination programs, and nine did not report outcomes in terms of life years even in cases where QALYs or DALYs were calculated. Only 13 studies adopted a societal perspective for analysis. All studies concluded that the appraised vaccination programs were cost-effective except for one evaluation of universal 7-valent pneumococcal conjugate vaccine (PCV-7) in children. However, three of the five studies on PCV-7 showed poor overall quality, and the number of studies on vaccines other than hepatitis B vaccine and PCV-7 was limited. In conclusion, major methodological flaws and reporting problems exist in current economic evaluations of vaccination programs in China. Local guidelines for good practice and reporting, institutional mechanisms and education may help to improve the overall quality of these evaluations.
本研究旨在系统回顾中国大陆开展的疫苗项目的经济学评价。我们在8个英文数据库和3个中文数据库中检索了2015年8月3日前发表的关于中国疫苗接种的经济学评价。每篇文章均依据19项健康经济标准共识清单（CHEC清单）进行评估。我们找到了23篇评估针对乙型肝炎（8篇文章）、肺炎链球菌（5篇文章）、人乳头瘤病毒（3篇文章）、日本脑炎（2篇文章）、轮状病毒（2篇文章）、甲型肝炎（1篇文章）、肠道病毒71型（1篇文章）和流感（1篇文章）疫苗的论文。研究符合CHEC清单标准中的平均12项（范围：6 - 18项）。6篇中文文章中有5篇符合的标准项目少于19项标准的一半。研究未符合的主要标准包括：治疗和/或疫苗接种成本的测量（20篇文章）和估值（18篇文章）不当、未讨论分配影响（18篇文章）、遗漏主要健康结局（14篇文章）、未讨论对其他情况的可推广性（14篇文章）以及敏感性分析不足（13篇文章）。此外，10项研究未纳入疫苗接种项目的主要成本组成部分，9项研究即使在计算了质量调整生命年（QALY）或伤残调整生命年（DALY）的情况下也未报告生命年方面的结局。只有13项研究采用社会视角进行分析。所有研究均得出结论，除了一项对儿童通用7价肺炎球菌结合疫苗（PCV - 7）的评估外，所评估的疫苗接种项目具有成本效益。然而，关于PCV - 7的5项研究中有3项整体质量较差，且除乙型肝炎疫苗和PCV - 7外，其他疫苗的研究数量有限。总之，中国目前疫苗接种项目的经济学评价存在重大方法缺陷和报告问题。良好实践和报告的地方指南、制度机制及教育可能有助于提高这些评价的整体质量。
